Revisiting RAAS blockade in CKD with newer potassium-binding drugs

Panagiotis I. Georgianos, Rajiv Agarwal

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Among patients with proteinuric chronic kidney disease (CKD), current guideline recommendations mandate the use of agents blocking the renin angiotensin aldosterone system (RAAS) as first-line antihypertensive therapy based on randomized trials demonstrating that RAAS inhibitors are superior to other antihypertensive drug classes in slowing nephropathy progression to end-stage renal disease. However, the opportunities for adequate RAAS blockade in CKD are often limited, and an important impediment is the risk of hyperkalemia, especially when RAAS inhibitors are used in maximal doses or are combined. Accordingly, a large proportion of patients with proteinuric CKD may not have the anticipated renoprotective benefits since RAAS blockers are often discontinued due to incident hyperkalemia or are administered at suboptimal doses for fear of the development of hyperkalemia. Two newer potassium binders, patiromer and sodium zirconium cyclosilicate (ZS-9), have been shown to effectively and safely reduce serum potassium levels and maintain long-term normokalemia in CKD patients receiving background therapy with RAAS inhibitors. Whether these novel potassium-lowering therapies can overcome the barrier of hyperkalemia and enhance the tolerability of RAAS inhibitor use in proteinuric CKD awaits randomized trials.

Original languageEnglish (US)
JournalKidney International
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Renin-Angiotensin System
Chronic Renal Insufficiency
Potassium
Hyperkalemia
Pharmaceutical Preparations
Antihypertensive Agents
Chronic Kidney Failure
Fear
Therapeutics
Guidelines
Serum

Keywords

  • Chronic kidney disease
  • Hyperkalemia
  • Patiromer
  • RAAS blockade
  • Sodium zirconium cyclosilicate

ASJC Scopus subject areas

  • Nephrology

Cite this

Revisiting RAAS blockade in CKD with newer potassium-binding drugs. / Georgianos, Panagiotis I.; Agarwal, Rajiv.

In: Kidney International, 01.01.2017.

Research output: Contribution to journalArticle

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